Texas Health and Human Services Commission
Medicaid for the Elderly
and People with Disabilities HandbookRevision: 14-2Effective: June 1, 2014

Q-6000

Qualified Disabled and Working Individuals (QDWI) –MC-QDWI

SSI policy is used to determine eligibility for the Qualified Disabled and Working Individuals (QDWI) Program – MC-QDWI. To be eligible for QDWI coverage, a person must:

be under 65 years of age;

be entitled to benefits under Medicare Part A;

not otherwise certified under any other Medicaid-funded program;

have a monthly income equal to or less than 200% of the federal poverty level; and

have no more than twice the countable resources allowed under the SSI program.

Resource Limits

Individual – $4,000

Couple – $6,000

Q-6100 QDWI Benefits

Revision 12-2; Effective June 1, 2012

Authorized under 42 USC §1396a(a)(10)(E)(ii), the QDWI Program pays only Medicare Part A premiums. A person cannot be eligible for regular Medicaid and QDWI coverage at the same time. The person does not receive a Your Texas Benefits Medicaid Card or Form H1027, Medical Eligibility Verification.

A person's QDWI eligibility begins in accordance with the coverage period described in §1818A of the Social Security Act (42 USC §1395i-2a(c)).

Q-6200 QDWI Income Limit

Revision 14-2; Effective June 1, 2014

A disabled person who receives Social Security disability payments and free Medicare is allowed to work. If his earnings exceed a certain amount over a period of time, the Social Security Administration may discontinue Social Security benefits and Medicare. Under Section 1818A of the Social Security Act, the person is entitled to purchase his Part A Medicare premium if his free Medicare is being denied because of earnings.

The monthly income limits for initial certification are:

Time Period

Person

Couple

Deeming*

March 1, 2014 to present

$1,945

$2,622

$677

March 1, 2013 to Feb 28, 2014

$1,951

$2,585

$670

March 1, 2012 to Feb 28, 2013

$1,862

$2,522

$660

March 1, 2011 to Feb 29, 2012

$1,815

$2,452

$637

March 1, 2009 to Feb. 28, 2011

$1,805

$2,429

$624

March 1, 2008 to Feb. 28, 2009

$1,734

$2,334

$600

April 1, 2007 to Feb. 29, 2008

$1,702

$2,282

$580

April 1, 2006 to March 31, 2007

$1,634

$2,200

$566

April 1, 2005 to March 31, 2006

$1,595

$2,139

$544

April 1, 2004 to March 31, 2005

$1,552

$2,082

$530

Jan. 1, 2003 to March 31, 2004

$1,497

$2,020

$523

Jan. 1, 2002 to Dec. 31, 2002

$1,477

$1,990

$513

Jan. 1, 2001 to Dec. 31, 2001

$1,432

$1,935

$503

Jan. 1, 2000 to Dec. 31, 2000

$1,392

$1,875

$483

Jan. 1, 1999 to Dec. 31, 1999

$1,374

$1,844

$470

Jan. 1, 1998 to Dec. 31, 1998

$1,342

$1,809

$467

Jan. 1, 1997 to Dec. 31, 1997

$1,315

$1,769

$454

Jan. 1, 1996 to Dec. 31, 1996

$1,290

$1,727

$437

Jan. 1, 1995 to Dec. 31, 1995

$1,245

$1,672

$427

Jan. 1, 1994 to Dec. 31, 1994

$1,227

$1,640

$413

Jan. 1, 1993 to Dec. 31, 1993

$1,162

$1,572

$410

Jan. 1, 1992 to Dec. 31, 1992

$1,136

$1,532

$396

Jan. 1, 1991 to Dec. 31, 1991

$1,104

$1,480

$376

July 1, 1990 to Dec. 31, 1990

$1,047

$1,404

$357

*The deeming amount is determined by subtracting the individual limit from the couple limit.

Q-6300 QDWI Cost-of-Living Adjustment

Revision 09-4; Effective December 1, 2009

QDWI does not receive the cost-of-living adjustment (COLA) during January and February as other Medicare Savings Programs do.

Q-6400 QDWI Medical Effective Date

Revision 09-4; Effective December 1, 2009

The medical effective date is influenced by whether the person enrolls for Medicare coverage during the initial enrollment period but before his present Medicare entitlement ends, after the initial enrollment period begins but after his entitlement ends, or following the initial enrollment period. Consider the date the person enrolled for continuation of his/her Medicare entitlement when determining the medical effective date (MED). The MED does not precede the earliest date the person is entitled to reinstatement of his Part A coverage. Otherwise, use the same procedures for determining the MED for all other MEPD programs (including three months prior coverage).

Example: The following chart may be used as a reference for the MED determination policies and examples.

Enrollment
Period

Month

Activities

Initial
Enrollment Period

April
May

Person notified his free Part A entitlement will end

June

End of person's free entitlement

July
August
September

First month person meets QDWI criteria

General
Enrollment Period

January
February

QDWI coverage effective July 1

March

End of general enrollment period

The following applies when determining the MED:

The initial enrollment period for a person who has been notified that his free entitlement to Medicare Part A coverage will end is seven months. The enrollment period begins the month the person is notified.

Example: A person is notified in April that his free entitlement to Part A coverage ends at the end of June. His initial enrollment period begins in the month of notification (April) and ends at the end of October. To reinstate his Part A coverage, he must enroll with SSA before the end of October. He then must apply with the department for QDWI benefits.

In the case of a person who enrolls in an initial enrollment period before meeting QDWI criteria and applies for QDWI benefits, the medical effective date is the first day of the month he meets the QDWI criteria.

Example: A person is notified in April that his free entitlement to Medicare Part A coverage ends at the end of June. He enrolls for reinstatement of his Part A coverage with SSA in April and applies for and is determined eligible for QDWI benefits with the department in May. The earliest MED he can have for QDWI benefits is July 1 because it is the first month he meets QDWI criteria and is allowed to purchase Part A coverage.

If the person enrolls in the first month that he meets all QDWI criteria except for reinstatement (fourth month of the initial enrollment period), and applies for QDWI benefits, the MED is effective the first of the following month.

Example: A person is notified in April that his free entitlement to Medicare Part A coverage ends at the end of June. He enrolls for reinstatement of his Part A coverage with SSA in July and applies for and is determined eligible for QDWI benefits in July. The earliest medical effective date he can have for QDWI benefits is Aug. 1 because that is the first month he is entitled to reinstatement of his Part A coverage.

If the person enrolls in the second month that he meets all QDWI criteria except for reinstatement (fifth month of the initial enrollment period) and applies for QDWI benefits, the MED is effective the second month after enrollment.

Example: A person is notified in April that his free entitlement to Medicare Part A coverage ends at the end of June. He enrolls for reinstatement of his Part A coverage with SSA in August and applies for and is determined eligible for QDWI benefits in September. The earliest MED he can have for QDWI benefits is Oct. 1 because that is the first month he is entitled to reinstatement of his Part A coverage.

If the person enrolls in the third or fourth month that he meets all QDWI criteria except for reinstatement (sixth or seventh month of the initial enrollment period) and applies for QDWI benefits, the medical effective date is effective the first day of the third month following the month he enrolled.

Example: A person is notified in April that his free entitlement to Medicare Part A coverage ends at the end of June. He enrolls for reinstatement of his Part A coverage with SSA in September and applies for and is determined eligible for QDWI benefits in October. The earliest MED he can have for QDWI benefits is Dec. 1 because that is the first month he is entitled to reinstatement of his Part A coverage.

If the person enrolls during the general enrollment period, the medical effective date is always effective July 1.

Example: A person is notified in April that his free entitlement to Medicare Part A coverage ends at the end of June. He does not enroll during the initial enrollment period and decides to enroll during the general enrollment period, from January through March 31, of the next year. The earliest MED date he is allowed is the July 1 following his enrollment.

Q-6500 General SSA Procedures Involving Potential QDWIs

Revision 09-4; Effective December 1, 2009

The Social Security Administration notifies disabled persons whose Social Security disability payments have ceased and whose Medicare coverage is about to cease because of earnings. A seven-month initial enrollment period begins with the month of notification. During this period, the person may enroll to pay the Medicare premium himself or he may contact the department to have his eligibility determined for QDWI benefits. If he does not take either of these actions, his Medicare coverage ends and he must wait until the next general enrollment period to enroll for Medicare coverage.

Reminder: Remember that entitlement to Medicare Part A is one of the eligibility criteria for receiving QDWI benefits.

Q-6600 QDWI Application Procedures

Revision 09-4; Effective December 1, 2009

Q-6610 Medicare Part A Entitlement

Revision 09-4; Effective December 1, 2009

Ask the person if he/she is entitled to Medicare Part A benefits.

If the person is currently enrolled, verify by checking:

the person's Medicare card;

a TPQY inquiry; or

the letter from the Social Security Administration (SSA) notifying the person of the imminent termination of Part A.

If the person has been entitled but is not currently enrolled, determine when his/her entitlement ended.

If entitlement has ended, but the person can still enroll during his/her initial enrollment period, refer him to SSA to begin enrollment procedures. He/She must obtain proof of enrollment from SSA.

If both entitlement and the initial enrollment period have ended, the person cannot be eligible for QDWI benefits until after enrolling with SSA during the general enrollment period (January through March of each year). QDWI benefits begin in July of the year of enrollment.